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More than 11 300 readers of the BMJ chose the introduction of clean water and sewage disposal—“the sanitary revolution”—as the most important medical milestone since 1840, when the BMJ was first published. Readers were given 10 days to vote on a shortlist of 15 milestones, and sanitation topped the poll, followed closely by the discovery of antibiotics and the development of anaesthesia.

The work of the 19th century lawyer Edwin Chadwick, who pioneered the introduction of piped water to people's homes and sewers rinsed by water, attracted 15.8% of the votes, while antibiotics took 15%, and anaesthesia took 14%. The next two most popular were the introduction of vaccines, with 12%, and the discovery …